Digital health systems strengthening in Africa for rapid response to COVID-19

Tobias F. Rinke de Wit; Wendy Janssens; Maxwell Antwi; Emmanuel  Milimo; Nick  Mutegi; Heri  Marwa; Njide  Ndili; Wasunna  Owino; Emma Waiyaiya; Diana Garcia Rojas; Monique  Dolfing; Aafke E. de Graaff; Ruan  Swanepoel; Mark H.  van der Graaf; Dorien  Mulder; Teresa De Sanctis; Santa  Kratule; Cem  Koyuncu; Khama  Rogo; Gloria P.  Gómez-Pérez; Nicole Spieker

doi:10.3389/frhs.2022.987828

Digital health systems strengthening in Africa for rapid response to COVID-19

Tobias F. Rinke de Wit, Wendy Janssens, Maxwell Antwi, Emmanuel Milimo, Nick Mutegi, Heri Marwa, Njide Ndili, Wasunna Owino, Emma Waiyaiya, Diana Garcia Rojas, Monique Dolfing, Aafke E. de Graaff, Ruan Swanepoel, Mark H. van der Graaf, Dorien Mulder, Teresa De Sanctis, Santa Kratule, Cem Koyuncu, Khama Rogo, Gloria P. Gómez-PérezNicole Spieker

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

The COVID-19 pandemic has painfully exposed the constraints of fragile health systems in low- and middle-income countries, where global containment measures largely set by high-income countries resulted in disproportionate collateral damage. In Africa, a shift is urgently needed from emergency response to structural health systems strengthening efforts, which requires coordinated interventions to increase access, efficiency, quality, transparency, equity, and flexibility of health services. We postulate that rapid digitalization of health interventions is a key way forward to increase resilience of African health systems to epidemic challenges. In this paper we describe how PharmAccess' ongoing digital health system interventions in Africa were rapidly customized to respond to COVID-19. We describe how we developed: a COVID-19 App for healthcare providers used by more than 1,000 healthcare facilities in 15 African countries from May–November 2020; digital loans to support private healthcare providers with USD 20 million disbursed to healthcare facilities impacted by COVID-19 in Kenya; a customized Dutch mobile COVID-19 triage App with 4,500 users in Ghana; digital diaries to track COVID-19 impacts on household expenditures and healthcare utilization; a public-private partnership for real-time assessment of COVID-19 diagnostics in West-Kenya; and an expanded mobile phone-based maternal and child-care bundle to include COVID-19 adapted services. We also discuss the challenges we faced, the lessons learned, the impact of these interventions on the local healthcare system, and the implications of our findings for policy-making. Digital interventions bring efficiency due to their flexibility and timeliness, allowing co-creation, targeting, and rapid policy decisions through bottom-up approaches. COVID-19 digital innovations allowed for cross-pollinating the interests of patients, providers, payers, and policy-makers in challenging times, showing how such approaches can pave the way to universal health coverage and resilient healthcare systems in Africa.

Original language	English
Article number	987828
Pages (from-to)	1-21
Number of pages	21
Journal	Frontiers in Health Services
Volume	2
DOIs	https://doi.org/10.3389/frhs.2022.987828
Publication status	Published - 28 Nov 2022

Funding

First, it proved challenging to secure rapid funding from institutional donors for quick adaptations and add-ons, due to their relatively intricate responsiveness to the emergency situation and subsequent prolonged lead times resulting from standard administrative processes. In that reality, it appeared more effective to move toward ad-hoc funding with dedicated private donors and foundations, particularly during the very first phase of emergency—even if those typically involve relatively small amounts, short timeframes, and each of those a different reporting format. The structural support of PharmAccess by the Netherlands Ministry of Foreign Affairs with flexible funding proved indispensable for quick action. We would like to thank all patients, healthcare providers and other people in Africa and elsewhere who trusted and used our COVID-19 digital interventions. We thank our funders, the Ministry of Foreign Affairs of the Netherlands, Achmea Foundation, FDOV (Facility for Sustainable Entrepreneurship and Food Security), Joep Lange Institute, John Martin Foundation, MSD for Mothers, Postcode Loterij, Pfizer Foundation, and The ELMA Relief Foundation for their trust and support. We gratefully acknowledge our colleagues in the PharmAccess offices in Ghana, Kenya, Nigeria and Tanzania for their hard work and dedication during the difficult times of the pandemic making the implementation of our COVID-19-digital interventions possible. Special thanks to our colleagues from the PharmAccess SafeCare, MomCare, Medical Credit Fund, Data Management, and Covid-Dx teams for their innovative approaches and creativity in adapting to the demands of the COVID-19 pandemic to keep bringing good quality care in our projects in Africa. Finally, we would like to express our special gratitude to Amanuel A. Abajobir and Caroline W. Wainaina at the African Population and Health Research Centre, Nairobi, Kenya for their hard work in data collection for the ‘Diaries' study described in this manuscript; and to Sandra Gip for her technical assistance with the creation of the figures of this manuscript. We would like to thank all patients, healthcare providers and other people in Africa and elsewhere who trusted and used our COVID-19 digital interventions. We thank our funders, the Ministry of Foreign Affairs of the Netherlands, Achmea Foundation, FDOV (Facility for Sustainable Entrepreneurship and Food Security), Joep Lange Institute, John Martin Foundation, MSD for Mothers, Postcode Loterij, Pfizer Foundation, and The ELMA Relief Foundation for their trust and support. We gratefully acknowledge our colleagues in the PharmAccess offices in Ghana, Kenya, Nigeria and Tanzania for their hard work and dedication during the difficult times of the pandemic making the implementation of our COVID-19-digital interventions possible. Special thanks to our colleagues from the PharmAccess SafeCare, MomCare, Medical Credit Fund, Data Management, and Covid-Dx teams for their innovative approaches and creativity in adapting to the demands of the COVID-19 pandemic to keep bringing good quality care in our projects in Africa. Finally, we would like to express our special gratitude to Amanuel A. Abajobir and Caroline W. Wainaina at the African Population and Health Research Centre, Nairobi, Kenya for their hard work in data collection for the ‘Diaries' study described in this manuscript; and to Sandra Gip for her technical assistance with the creation of the figures of this manuscript. The research reported here has received funding from the Ministry of Foreign Affairs of the Netherlands, Achmea Foundation, FDOV (Facility for Sustainable Entrepreneurship and Food Security), Joep Lange Institute, John Martin Foundation, MSD for Mothers, Postcode Loterij, Pfizer Foundation, and The ELMA Relief Foundation.

Funders	Funder number
Achmea Foundation
ELMA Relief Foundation
FDOV
Facility for Sustainable Entrepreneurship and Food Security
Joep Lange Institute
John Martin Foundation
Netherlands Ministry of Foreign Affairs
Meso Scale Diagnostics
Pfizer Foundation
Ministerie van Buitenlandse Zaken
African Population and Health Research Center

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3389/frhs.2022.987828

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Editors’s Paper of the Year Award 2023
Janssens, Wendy (Recipient), 2023
Prize / Grant: Prize › Academic

Cite this

de Wit, T. F. R., Janssens, W., Antwi, M., Milimo, E., Mutegi, N., Marwa, H., Ndili, N., Owino, W., Waiyaiya, E., Garcia Rojas, D., Dolfing, M., de Graaff, A. E., Swanepoel, R., van der Graaf, M. H., Mulder, D., De Sanctis, T., Kratule, S., Koyuncu, C., Rogo, K., ... Spieker, N. (2022). Digital health systems strengthening in Africa for rapid response to COVID-19. Frontiers in Health Services, 2, 1-21. Article 987828. https://doi.org/10.3389/frhs.2022.987828

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abstract = "The COVID-19 pandemic has painfully exposed the constraints of fragile health systems in low- and middle-income countries, where global containment measures largely set by high-income countries resulted in disproportionate collateral damage. In Africa, a shift is urgently needed from emergency response to structural health systems strengthening efforts, which requires coordinated interventions to increase access, efficiency, quality, transparency, equity, and flexibility of health services. We postulate that rapid digitalization of health interventions is a key way forward to increase resilience of African health systems to epidemic challenges. In this paper we describe how PharmAccess' ongoing digital health system interventions in Africa were rapidly customized to respond to COVID-19. We describe how we developed: a COVID-19 App for healthcare providers used by more than 1,000 healthcare facilities in 15 African countries from May–November 2020; digital loans to support private healthcare providers with USD 20 million disbursed to healthcare facilities impacted by COVID-19 in Kenya; a customized Dutch mobile COVID-19 triage App with 4,500 users in Ghana; digital diaries to track COVID-19 impacts on household expenditures and healthcare utilization; a public-private partnership for real-time assessment of COVID-19 diagnostics in West-Kenya; and an expanded mobile phone-based maternal and child-care bundle to include COVID-19 adapted services. We also discuss the challenges we faced, the lessons learned, the impact of these interventions on the local healthcare system, and the implications of our findings for policy-making. Digital interventions bring efficiency due to their flexibility and timeliness, allowing co-creation, targeting, and rapid policy decisions through bottom-up approaches. COVID-19 digital innovations allowed for cross-pollinating the interests of patients, providers, payers, and policy-makers in challenging times, showing how such approaches can pave the way to universal health coverage and resilient healthcare systems in Africa.",

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de Wit, TFR, Janssens, W, Antwi, M, Milimo, E, Mutegi, N, Marwa, H, Ndili, N, Owino, W, Waiyaiya, E, Garcia Rojas, D, Dolfing, M, de Graaff, AE, Swanepoel, R, van der Graaf, MH, Mulder, D, De Sanctis, T, Kratule, S, Koyuncu, C, Rogo, K, Gómez-Pérez, GP & Spieker, N 2022, 'Digital health systems strengthening in Africa for rapid response to COVID-19', Frontiers in Health Services, vol. 2, 987828, pp. 1-21. https://doi.org/10.3389/frhs.2022.987828

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T1 - Digital health systems strengthening in Africa for rapid response to COVID-19

AU - de Wit, Tobias F. Rinke

AU - Janssens, Wendy

AU - Antwi, Maxwell

AU - Milimo, Emmanuel

AU - Mutegi, Nick

AU - Marwa, Heri

AU - Ndili, Njide

AU - Owino, Wasunna

AU - Waiyaiya, Emma

AU - Garcia Rojas, Diana

AU - Dolfing, Monique

AU - de Graaff, Aafke E.

AU - Swanepoel, Ruan

AU - van der Graaf, Mark H.

AU - Mulder, Dorien

AU - De Sanctis, Teresa

AU - Kratule, Santa

AU - Koyuncu, Cem

AU - Rogo, Khama

AU - Gómez-Pérez, Gloria P.

AU - Spieker, Nicole

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DO - 10.3389/frhs.2022.987828

M3 - Article

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JO - Frontiers in Health Services

JF - Frontiers in Health Services

M1 - 987828

ER -

Digital health systems strengthening in Africa for rapid response to COVID-19

Abstract

Funding

UN SDGs

Access to Document

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Prizes

Editors’s Paper of the Year Award 2023

Cite this